Tuesday, June 10, 2008

Do Nurses Have The Time?

The new trend in hospital satisfaction is called “scripting.” Hospitals seemed to have paid some company to do a survey on patient satisfaction and it seems that people have stated that they feel that the nurse doesn’t have time for them. The answer to the problem? Nurses are now mandated to script to patients with the last sentence being “Is there anything else I can do for you? I have the time.” Some institutions have even changed policies to force the nurses to all wear the same color for example a drab boring dark blue. This was in response to other complaints that people do not know who the nurses are. Hospitals have become competitive within the realm of “customer service” and actual patient care is a vintage act. Instead of focusing on safe patient care, they are more concerned with images.

Patients and families are fully aware that nurses spend very little time at the bedside doing patient care. Some people are under the impression that it is because of the new wave of computer technology. They see nurses at the computers charting and they believe that is what is taking them away from time with the patient. Other people may be convinced that their nurse is lazy and is off reading a magazine somewhere. While every job classification may have the “magazine reader,” this is not the problem.

The truth behind this scene is that patient care has become more complex and the resources have decreased equally if not more for nurses. Hospital settings have become a revolving door for employment with a new concept revolving called “Magnet Status” which means that employees are happy so the care will be better. Basically, this is another administrative forced expectation that encourages employees to vote to help their hospital receive this “Magnet Status” when in all reality there are still underlying issues within employment and job satisfaction.

Nurses have a wide multitude of expected tasks throughout an eight or twelve hour shift. They are expected to exchange report on their patients, check patient’s orders, medications and labs, sometimes immediately start their shift following up on a task that was passed on to them by the previous shift. They are supposed to start their shift off by checking on, meeting and assessing their patients. If everything is going well, they begin to pass medications which requires applying experience, skills and training because specific laboratory results or patient conditions may require a change in any given medication. Throughout the day there will be expected and scheduled treatments which include dressing changes or repetitive assessments to keep a patient stable. The reality of nursing is that on a “medical/surgical” unit with a nurse being responsible for 5 patients, her tasks alone can easily consume an eight or twelve hour shift. Now add interruptions with phone calls, water, blankets, bed changes, assisting patients to the bathroom and even waiting on families and visitors who seem to think that nurse is another word for “waitress.” In a regular eight to twelve hour day the nurse finds herself behind on the important tasks of patient care trying to maintain “customer satisfaction” with a smile while addressing interruptions. Using the words; “I do not have the time right now” can send the nurse right to the unemployment line with absolutely no reference for any time spent on the job.

Another dilemma that nurses face is the concept behind “assistive personnel.” The actual job that the nurse has to perform is increased due to the fact that they are supplied with various levels of “assistive personnel.” One of the common problems with this is that the “assistive personnel” may be extremely busy or rebellious towards the nurse resulting in the nurse taking on more of the interruptions and other tasks that takes the nurse away from her expected duties and patient care. Often times, there is a great imbalance within the “assistive personnel” where there might be one reliable tech to every unreliable tech. This not only increases the demands on the tech but the nurse as well. Another imbalance is the experience of staff where there is a mixture of inexperienced new nurses and new techs due to the “revolving door” effect from either job dissatisfaction or movement within the field. This is an on-going event in facilities. Some facilities will have the techs responsible for 10 to 20 patients while nurses care for 5 – 8 or even 10 patients. In all reality, with a patient load that heavy a nurse can easily spend her whole shift practically just trying to pass medications. Add the interruptions and…well…customer satisfaction goes down and the facility administrators come up with more “tasks” to improve the “customer satisfaction” but not the quality of care.

Over the years, expectations, tasks and documentation have increased along with the number of patients a nurse will manage. The mix of the expectations, tasks and documentation is more than an eight or twelve-hour shift can handle. Safe nurse to patient ratios have been mentioned for years as the “nursing shortage” increases and nothing is being done to actually address “safe patient care.” There are hundreds of thousands of licensed inactive nurses that are not working with over 50% specifically stating that it is because of the unsafe conditions. There isn’t much data to report the number of nurses that are actively working in patient care but are unhappy with the unsafe conditions. This is partly due to the repercussions of administration – if you get caught speaking up, you will find yourself one of many nurses looking for employment without a reference.

Unfortunately, the public seems to be fairly educated about the conditions for nurses but in their attempts to speak up, more demands fall upon the nurses to hush the public and hide the problem within the facilities.

“Magnet Status” seems to be ironic with many facilities trying to obtain the status while being staffed in large numbers by “supplemental staffing.” If the facility were such a great place to work, you would think they would have adequate staff to cover their needs without the need to utilize outside agencies or even internal supplemental staff to fill the holes.

While many nursing unions or groups have mentioned safe nurse to patient ratios, nothing seems to be happening to make the change towards what we consider “safe patient care.” Instead, we will continue to “shop” for medical care with the hospitals competing against each other with bigger flat screen televisions and nurses waiting on unimportant demands from the “customers” while struggling to provide safe care to their patients. The data to support the fact that the more patients the nurse manages increases the likelihood of mistakes and poor patient outcomes seems to mean nothing in the competitive world of health care. Numerous articles and statistics have reiterated this problem for years but nothing is changing except for the number of tasks and patients that the nurse is responsible for and that number keeps getting bigger and bigger.

Seems the only thing we can do as customers within this outrageous scenario is to stay educated, keep yourself healthy, try to avoid hospital stays and keep a very close eye on your care.

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